382例恶性黑素瘤预后影响因素分析

目的 探讨影响恶性黑素瘤患者预后的相关因素。方法 回顾性分析433例恶性黑素瘤患者的临床和随访资料，选择13个对预后可能产生影响的因素进行Cox回归分析。生存分析采用寿命表法，多因素分析采用Cox模型，计算患者的预后指数（PI），将患者分组，计算不同组患者的期望生存曲线。结果 影响恶性黑素瘤患者长期生存的因素分别为肿瘤分期（RR = 1.56，P = 0.00）、性别（RR = 0.69，P = 0.01）、部位（RR = 1.06，P = 0.01）、肿瘤厚度（RR = 1.13，P = 0.04）及手术切除范围（RR = 0.72，P = 0.00）。根据预后指数的中位数将患者分为高危组和低危组，两组患者的中位生存时间分别是14.0个月、95.3个月，组间比较有统计学意义（P < 0.01）。结论 肿瘤分期、性别、部位、肿瘤厚度及手术切除范围是影响恶性黑素瘤患者生存期的因素，PI值可用于预测恶性黑素瘤患者的预后。

Analysis of prognostic factors in 382 patients with malignant melanoma

Objective To investigate the prognostic factors of malignant melanoma. Methods The clinical and follow-up data were retrospectively analyzed in 382 patients with malignant melanoma admitted to the hospital from the January of 1985 to the December of 2004. A multivariate analysis was performed by the Cox proportional hazard model. The survival rate was determined by life table method. Prognostic index was calculated based on the Cox regression analysis. According to the prognostic index value, the patients were classified into high and low hazard groups; survival curve was drawn for the two groups of patients. Results As shown by the Cox regression analysis, the factors influencing the survival rate included tumor staging （RR = 1.56, P = 0.00）, patients′ sex （RR = 0.69, P = 0.01）, tumor site （RR = 1.06, P = 0.01）, tumor thickness（RR = 1.13, P = 0.04）, operation scope（RR = 0.72, P = 0.00）. The median survival period was 14.0 and 95.3 months in the low and high hazard groups, respectively; the difference between these two groups was statistically significant （P < 0.01）. Conclusions Tumor staging, thickness and site, patients′ sex, and operational scope are important prognostic factors. The prognostic index might be used to predict the prognosis of malignant melanoma.